Page 209 - HA Convention 2016 [Full Version]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F5.2 Healthcare Advances, Research and Innovations 09:00 Room 421

Use of 2% Aqueous Chlorhexidine Swabstick in Treating Peritoneal Dialysis Catheter Exit-site Granuloma — a
Case Series Study
Hui YH 1, Leung JTW 2, Chan AKH 3, Ho OY 3, Ho TL 2, Wong SSH 3, So WKW 4
1Nursing Service Department, United Christian Hospital, 2Department of Medicine, Tseung Kwan O Hospital, 3Renal Unit,
Department of Medicine and Geriatrics, United Christian Hospital, 4The Nethersole School of Nursing, Faculty of Medicine, The

Chinese University of Hong Kong, Hong Kong

Introduction Wednesday, 4 May

Exit-site granuloma is one the most frequent complications associated with peritoneal dialysis (PD) catheter. Granuloma
cauterisation with silver nitrate is the usual treatment in Hong Kong. However, the use of silver nitrate may cause
discolouration and damage to the surrounding healthy skin. The use of 2% Aqueous Chlorhexidine (CHG) Swabstick was
intended to treat the acute exit-site infection with purulent discharge before cauterisation. However, it was observed in a local
centre that the granulomas reduced in size and finally subsided in two PD patients without adverse effect. Therefore, a case
series study was conducted to examine the effect of 2% CHG Swabstick in treating PD Catheter exit-site granulomas.

Objectives

(1) To evaluate the effectiveness of using 2% CHG Swabstick in treating PD Catheter exit-site granulomas; and (2) to examine
any adverse effects after using the 2% CHG Swabstick.

Methodology

Patients developed PD catheter exit-site granulomas were identified during follow-up in the two Renal Centres in Kowloon
East Cluster. All eligible patients were trained and followed-up by a specialty nurse/nurse consultant. They were trained to use
the 2% CHG Swabstick for daily exit-site dressing at home and were followed-up within four weeks or earlier if granulomas
healed to determine progress of healing after the training session. The primary outcome was time-to-granuloma subside and
the secondary outcomes were adverse effects (pain, infection) of the use of 2% CHG Swabstick.

Results

18 PD patients consented to join the study from the two Renal Centres from April to August 2015. Three patients dropped out
because of allergy (n=1) and loss follow-up (n=2). 11/15 (73%) showed good response to 2% CHG Swabstick with granulomas
subsided from 3 to 28 days (mean 13.2 days). Their size of granulomas at baseline ranged from 3 x 2 mm to 10 x 7 mm. 27%
(n=4) required to change to silver nitrate as little or no improvement after 14 to 25 days. For adverse effect, Numeric Rating
Scale was used to assess pain: both the median and mode were 0 and the range was 0-2 out of 11 rated by 18 patients. Four
patients with exit-site infection and antibiotics were given.

Conclusion

This case series study illustrated that the use of 2% CHG Swabstick is effective and safe in treating PD Catheter granulomas.
Prospective randomised control trial is recommended to perform in order to evaluate the efficacy of using 2% CHG
Swabstick in treating the PD catheter exit-site granulomas.

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